Provider Demographics
NPI:1437608155
Name:WYANT, AIMEE (PA-C)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:
Last Name:WYANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:AIMEE
Other - Middle Name:
Other - Last Name:THORNTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 WALDEN WAY
Mailing Address - Street 2:
Mailing Address - City:IMPERIAL
Mailing Address - State:PA
Mailing Address - Zip Code:15126-9619
Mailing Address - Country:US
Mailing Address - Phone:412-403-3321
Mailing Address - Fax:
Practice Address - Street 1:720 BLACKBURN RD
Practice Address - Street 2:
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1459
Practice Address - Country:US
Practice Address - Phone:412-741-6600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA058439363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant